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Survey of newborn direct antiglobulin testing practice in United States and Canadian transfusion services
Author(s) -
Crowe Elizabeth P.,
Goel Ruchika,
Andrews Jennifer,
Meyer Erin K.,
Wong Trisha E.,
Sloan Steven R.,
Delaney Meghan,
Lieberman Lani,
Cushing Melissa M.
Publication year - 2021
Publication title -
transfusion
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.045
H-Index - 132
eISSN - 1537-2995
pISSN - 0041-1132
DOI - 10.1111/trf.16335
Subject(s) - medicine , abo blood group system , umbilical cord , transfusion medicine , newborn screening , abo incompatibility , pediatrics , cord blood , blood transfusion , obstetrics , immunology
Abstract Background We hypothesized that variability in practice exists for newborn immunohematology testing due to lack of consensus guidelines. We report the results of a survey assessing that variability at hospitals in the United States and Canada. Study Design and Methods An AABB Pediatric Subsection working party developed and validated a survey of newborn immunohematology testing practice. The survey was sent electronically to transfusion service leadership at teaching institutions. Results The response rate was 67% (61/91); 56 surveys meeting inclusion criteria were analyzed. Approximately 90% (50/56) were from birth hospitals and 16.1% (9/56) were from pediatric hospitals. Newborn immunohematology testing is ordered as a panel by 66.0% (33/50) of birth hospitals. ABO group and DAT is mandated before discharge in 14/56 (25.0%) and 13/56 (23.2%), respectively. About 76.8% (43/56) selectively perform a DAT according to blood blank or clinical parameters. The most common DAT practices include anti‐IgG only testing by 73.2% (41/56) and use of umbilical cord specimen type by 67.9% (38/56). A positive DAT is a critical value for 26.8% (15/56) and followed with eluate testing when a maternal antibody screen is positive for 48.2% (27/56). In the setting of a non‐ABO maternal red cell antibody, 55.4% (31/56), phenotype neonatal red cells when the DAT is positive. Group O RBC are transfused irrespective of the DAT result for 82.1%, (46/56). Conclusion There is variability in newborn immunohematology testing and transfusion practice and potential overutilization of the DAT. Evidence‐based consensus guidelines should be developed to standardize practice and to improve safety.